South Hohl Kondo 2018

Methods:
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The vacant lot greening intervention involved the cleaning and greening of vacant lots via a standard, reproducible process of removing trash and debris, grading the land, planting new grass and a small number of trees, installing a low wooden perimeter fence with openings, and performing regular maintenance (Figure 2).
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The researchers turned various selected vacant lots into green spaces by clearing garbage, levelling the ground, plants grass and trees, adding fencing and maintained them regularly. This was different from simply just cleaning up because they also tried to greenify the location to test their hypothesis.

Introduction:
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However, these prior studies have not been experimental and have not tested mental health outcomes. Given this, we evaluated data from, to our knowledge, the first citywide cluster randomized trial with the objective to test the effects of inexpensive, standardized, and reproducible vacant land remediation interventions—greening and trash cleanup—on health and safety.
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Earlier studies suggested that improving vacant land might help communities, but they only observed associations and did not experimentally test mental health. The researchers therefore executed an experiment to see if improving vacant lots by greenifying could cause changes on health and safety.

Results:
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Intention-to-treat analyses of the greening intervention compared with no intervention demonstrated a significant decrease in feeling depressed (−41.5%; 95% CI, −63.6% to −5.9%; P = .03) and feeling worthless (−50.9%; 95% CI, −74.7% to −4.7%; P = .04).
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People living near greened lots reported less depression and fewer feelings of worthlessness after the greening intervention. The P values were below .05, so the authors considered these decreases statistically significant rather than likely being due to random chance.

Discussion:
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These results add much needed experimental evidence to a growing body of literature calling for structural changes to neighborhoods as a method for improving health and safety. This study extends previous work showing a clear association between green space and mental illness, by demonstrating that adding green space to people’s neighborhood environment can improve the trajectory of their mental health.

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This study provides strong evidence that changing the physical neighbourhood environment can improve mental health. The authors suggest that adding green space may be a practical method to support mental health being in a community.

Future Directions:
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What future research should follow up on this work?
Future research should follow residents for several years and repeat the experiment in other cities to determine whether the mental health benefits last and apply to different demographics. Researchers could also track how the green space was used by the residents that led to the improvement in their mental health.

Difficult Material:
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What did you not understand about this paper that someone else may be able to help you with? Or, if you understood everything, what did you find most challenging to understand?
The most challenging part was understanding the intention to treat and difference in differences statistical analyses, especially how the confidence intervals and P values were used to isolate the effect of the intervention. I understood the overall findings, but the statistical method was the hardest part to interpret.